Indirect questioning used by medical students in simulated oncology interviews: an exploratory study of the I don’t know question format

Background: This exploratory study examined the motives of medical students (first year of Master’s degree) (N=63) for using indirect questions of the type I don’t know if [you have already heard about chemotherapies], I don’t know how [you feel], or I don’t know what [kind of job you have] in simulated patient interviews during a communication skills course on breaking bad news.

Methods: The I don’t know question format was observed during an assessment of students’ communication skills by means of the Roter Interaction Analysis System (RIAS). Its recurrence in the students’ videotaped interviews led to this exploratory study. The I don’t know questions (IDK-Qs) were subjected to a qualitative content and discourse analysis considering their context, their discursive content (biomedical, psychosocial, etc.), their intent (specific, probing or exploratory) and their effect on the simulated patients (blocking or inviting verbal expression). To assess the specificity of students’ IDK-Qs, their prevalence was compared with a data set of oncologists (N=31) conducting videotaped interviews with simulated patients in the context of a Communication Skills Training.

Results: 26 of the 63 (41.3%) students asked 1-6 IDK-Qs during the interviews (with a total of 53 occurrences). The IDK-Qs were attributed to three broad content categories: medical/treatment questions (N=24); lifestyle/psychosocial questions (N=18); and “inviting questions” questions (N=11). Most of the IDK-Qs (46/53) seemed to have an exploratory function, with simulated patients providing detailed responses or asking for more information (36/53). IDK-Qs were rare in the oncologist sample compared to the student sample (5 vs. 53 occurrences, 4/31 oncologists vs. 26/63 students).

Discussion: IDK-Qs showed a question format difference between medical students and oncologists in simulated patient interviews. Among other interpretations, it has been assumed that IDK-Qs can constitute a protective linguistic strategy and a marker for psychological discomfort. The fact that in most cases the simulated patients responded extensively to IDK-Qs suggests that they did not have a blocking effect.